| NPI | 1790780013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35-082127) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 35082127) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2012-05-24 |